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General NPI Number Information
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NPI Number | 1558492421
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Entity Type | Organization
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Legal Business Name | CAMDENTON MEDICAL CENTER PHARMACY
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1930 NORTH STATE HWY 5 UNIT 1C
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City | CAMDENTON
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State | MO
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Zip | 65020-1930
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Country | US
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Telephone | 573-346-2300
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Fax | 573-346-8409
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Provider Business Mailing Address
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Address Line | 1930 NORTH STATE HWY 5 UNIT 1C
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City | CAMDENTON
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State | MO
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Zip | 65020-1930
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Country | US
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Telephone | 573-346-2300
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Fax | 573-346-8409
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | RONALD GENE HOLMAN
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Credential | RPH
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Telephone | 573-346-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 028456
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License Number State | MO
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